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Seizures With Liver Failure

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Dear Steve,
I have been treating a 6 yr yellow lab since 9/2008 for severe seizures. The dog was having 1-2 seizures, bad, per week on 6.5 mg/kg phenobarb BID and 300 mg zonisamide BID. The dog has improved greatly since then on a home cooked diet, with weight loss, and CHinese herbal medications. (it is on College Brain as my seizure case.)
The weird thing about this dog is it had seizures within 6 hours after either tonifying or draining AP, so has had no AP for 6 months.
Had to decease zonisamide 3 months ago as he developed signs of toxicity as he lost weight, and phenobarb dose decreases have maintained a constant mg/kg phenobarb dose. Serum phenobarb=34 (10-40).
I ran bloodwork on Dylan a couple weeks ago to check liver values as I have been slowly weaning him down to 5 mg/kg phenobarb, and discovered that his albumin is 1.7, chol, gluc, BUN are all low. So-Liver failure/Blood deficiency. Temporal muscle atrophy (Damp Heat, Yin deficiency, GB channel). Shen-quiet, slightly depressed (qi/Blood deficiency). T=dry, dark lavender with light pink edges. Bloid deficiency, Liver Qi stagnation Pulses rapid, wiry, decreased both Kidney positions.Kidney Yin/Yang/Qi/Jing deficient, stagnant, Heat RX currently=TNGTY with Jiang Can 10%, silymarin 250 mg BID, lactulose 5 ml q8hr, and Bao Hu Jiang Ju Tang 2 gm BID, Std Process Hepatic Support, egg whites in diet for albumin increased serum alb to 1.9.
I did not see much evidence of Phlegm on exam, T&P, but the only big change has been that I discontinued Di Tan Tang to give Bao Hu Jiang Ju Tang.
So-I have Liver Blood deficiency, Internal Wind-Phlegm, Yang rising. The seizures are severe-tonic-clonic type and getting worse with the current meds.
Can I use Ding Xian Wan, with Quan Xie and centipede, in a dog with a failing liver? Should I maybe use Tao Hong Si Wu Tang for Liver Blood?
This is a tough case, but I don't want to euthanize the dog without being aggressive enough and Ding Xian Wan is what I've gone to in the past for these (without Liver failure)
Ideeas about maybe a brain tumor and XFZYT?
Thanks,
Jodi

by naturevet

June 18, 2009

How long have you been using the TMGTY? Has it had a decent chance to respond? If not, I'd give it some time.

If it is not helping, then all I can tell you is what we are trying with these cases. We don't have enough experience yet to be sure this will help, but we've been trying Tou Nong San (without anteater scales). I believe Mona can make this up for you. It's not commercially available. Although it addresses Phlegm, we haven't seen a lot of Phlegm in the dogs that appear to be benefiting. In fact, they appear much as your patient - often deficient, yet not responding to TMGTY. So if you want to be part of an active experiment, then give it a try. Conventionally speaking, it's my impression that Keppra is most likely to work in this type of case than any other, so that's another option for you to explore.

Steve

by

June 19, 2009

This dog has had TMGTY from the beginning. I started slowly with 1/2 gm BID for an 80 lb (at the time) dog of each BXBZTMT and TMGTY. I had to d/c the herbs for a week, then start even lower as the dog got severely ataxic after just a couple doses of herb.
I will try the Keppra, as it looks like it is metabolized independent of the liver. Then I'll order the Tou Nong San from Mona Monday. Keep you posted.
thanks again,
Jodi

by

July 26, 2009

Dear Steve,
Wanted to give you an update on this case. I started the Keppra at 250 mg TID, and have gradually changed to 1 gm TNGTY BID with Tou Nong San 2 gm BID. The dog has also started shedding excessively, and had a brief period of urinary incontinence so I added 15 g Jin Suo Gu Jing Wan to 100 g TMGTY. I have decreased the phenobarb to 3 mg/kg BID (down from 8 mg/kg BID). Dylan had one seizures, not right after eating, so I doubled the midday Keppra. He is pulling the owners along on walks and has a bright Shen again.
His tongue is pale purple with pink edges, pulses sl wiry, mid postion at Liver, left>right. AND HIS ALBUMIN IS 2.4!, with only a MILDLY ELEVATED ALT!!!!!
Sso, first, thank you for your suggestion!!!!! Dylan has escaped the freezer once again! I am leaving everything the same except adding cod liver oil and a vitamin for the shedding, and beans for a non-meat protein source. He is otherwise well-supplemented.
COuld you tell me what is in Tong Nou San, or where to find the formula? And also any insight on where you see your cases go from here?
I am going to continue to overlap the TMGTY+Jin Suo Gu Jian Wan and Tou Nong San unless there is a reason not to.
The owners are ecstatic. I told them the change was not my idea.
Take care. Dylan thanks you too.
Jodi

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